A nurse is caring for a client.
Complete the following sentence by using the list of options.
The first two actions the nurse should take are
The Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A"}
Place the client in a private room (Option 1): Given the positive test results for tuberculosis (TB) exposure, placing the client in a private room is crucial for infection control. This helps prevent the spread of TB, which is a highly contagious disease, to other patients and healthcare staff. Isolation is a standard precaution for patients suspected of having active TB.
Apply supplemental oxygen (Option 2): The client's oxygen saturation is low at 88% on room air, indicating hypoxemia. Administering supplemental oxygen is essential to improve the patient's oxygen levels, ensure adequate tissue perfusion, and address any respiratory distress the patient may be experiencing.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Wearing shoes with smooth soles can increase the risk of slipping; shoes should have good traction for safety.
B. When using a cane, the proper sequence is to move the cane and the weaker leg forward together, then follow with the stronger leg. This provides support as the weaker leg advances.
C. While moving the cane forward is necessary, the distance should typically be short and adjusted based on the client's comfort and stability.
D. The cane should be held on the stronger (unaffected) side to provide support and stability while moving the weaker leg. This technique promotes proper weight distribution and balance during ambulation.
Correct Answer is B
Explanation
A. Moisturizing soap can leave a residue that may interfere with adhesion and is not recommended for stoma care.
B. Pressing the skin barrier for 30 seconds helps to ensure adhesion, which is necessary to prevent leakage and skin irritation.
C. The skin barrier opening should be cut close to the size of the stoma (about 1/8 inch larger) to prevent skin irritation and protect the peristomal skin.
D. Talc powder is not recommended, as it can interfere with the adhesive properties of the barrier.
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